Date: October 31, 2022
To: Enrolled Physicians, Advanced Practice Registered Nurses, Physician Assistants, Local Health Departments, Encounter Rate Clinics, Federally Qualified Health Centers, Rural Health Clinics, Hospitals, and Pharmacies
Re: COVID-19 Bivalent Booster Vaccination Age Range Lowered
This notice provides an update
in coverage of the new COVID-19 bivalent boosters. The update applies to claims
for customers covered under traditional Medicaid fee-for-service (FFS) and
the HealthChoice Illinois (HCI)
managed care organization (MCO) plans.
By practitioner provider
notice dated September 30, 2022, and pharmacy provider
notice dated October 5, 2022, the minimum age for the Pfizer-BioNTech bivalent
booster was identified as 12 years. The Moderna bivalent booster minimum age
was 18 years.
Effective October 12,
2022, the U.S. Food and Drug Administration (FDA), in association with the
Center of Disease Control (CDC), authorized the administration of the Pfizer-BioNTech
bivalent booster beginning at 5 years of age and the Moderna bivalent
booster beginning at 6 years of age. All other information in the above-referenced
provider notices remains the same.
The HFS COVID-19 Fee Schedule has been
updated. Questions regarding vaccine administration may be directed to the
Bureau of Professional and Ancillary Services at 877-782-5565 for the FFS
program, or the applicable HCI MCO plan.
Division of Medical Programs